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Download DEFINITION OF MENTAL ILLNESS
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Mental Illness (Adult) KNR 270 Mental Illness Effects 50 million in US 5-7% of adults have a serious mental illness 5-9% of children World Health Organization notes MI is the leading disability world-wide Only about ½ seek help Stigma and discrimination Society fears people with MI are violent DEFINITION OF MENTAL ILLNESS Behavior that significantly deviates from the norm Society sets standards for norm As society becomes more pluralistic, fewer behaviors will be considered abnormal Society can change criteria of normal or abnormal CRITERIA Consistently inappropriate Evidenced for some duration Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR, 2000) American Psychiatric Association Leisure functioning is part of criteria DSM-IV-TR Detailed classification system Used to design treatment Rated on 5 axes Axis I: Clinical Syndromes (Current Condition) Disorders evident in infancy, childhood, or adolescence Substance-related Schizophrenia & other psychotic disorders Mood disorders Anxiety disorders Factitious disorders Somatoform disorders Dissociative disorders Delirium, dementia, amnesic, & other cognitive disorders Sexual & gender identity disorders Eating disorders Sleep disorders Impulse control disorders Adjustment disorders Axis II: Longstanding Conditions Associated with Personality Disorders & Mental Retardation Axis II only used to identify a longterm underlying problem Personality disorders: paranoid, schizoid, histrionic, narcissistic, antisocial, borderline, obsessivecompulsive Mental retardation Remaining axes used to identify factors contributing to or being affected by disorder Axis III: General medical conditions Axis IV: Psychosocial & environmental problems Physical problems Psychosocial stress Axis V: Global Assessment of Functioning Scale (GAF) Current level of adaptive functioning in social relationships, occupational functioning, and use of leisure time MI subdivided Neuroses Most frequent Recognizes presence of maladaptive behavior & effect on person Mild depression, anxiety, phobia Psychoses More serious Lack of realization that behaviors is obvious or present Unable to objectively evaluate reality Schizophrenia SCHIZOPHRENIA(S) Not multiple or split personalities More of a disintegration of personality, departure from reality Thought disorder Often diagnosed 15-25 Stress can aggravate Effect on person’s future Could be gradual or sudden onset Heavy pot smoking might raise risk Schizophrenia Criteria: 2 or more of: Delusions Only 1 if delusion is bizarre, such as being abducted in a space ship from the sun Hallucinations Only 1 if at least 2 voices talk to one another or a voice keeps a running commentary in thoughts Schizophrenia Criteria: 2 or more of: Speech Incoherent, disorganized Negative symptoms Flat affect, reduced speech, lack of volition, deteriorating personal hygiene, increased suspicion people are talking behind one’s back SCHIZOPHRENIA Delusions Disturbance in content of thought Persecutory or paranoid Thought broadcasting Thought insertion Grandiose Religious SCHIZOPHRENIA Hallucinations Disturbances in perceptions Most often auditory “Voices” speak to the person Tactile Could be connected to any sense Visual is rare unless drug or alcohol abuse SCHIZOPHRENIA Other problems Hard time making choices or decisions Hard time thinking clearly Socially withdrawn Flat or blunted affect Lack of interest or joy Loose associations Word salad or nonsense words Types of Schizophrenia Paranoid type Disorganized type Preoccupied with delusions or frequent auditory hallucinations Disorganized behavior & speech, affect that is flat or inappropriate Catatonic type Stupor or motor immobility, mutism or marked negativism, peculiar posturing, mannerisms or grimacing, echolalia SCHIZOPHRENIA (S) Thought to be a chemical imbalance Symptoms may be controlled by meds Predictors of poor outcome Early age onset, family history, withdrawal, prior history Can be side effects to medication Tardive dyskensia Involuntary movements of tongue, face, mouth, or jaw associated with long-term use of antipsychotics May be irreversible Mood or Affective Disorders Depression Mania Bipolar DEPRESSION Different than everyday sadness Impairs everyday functioning Diminished interest or pleasure Fatigue and energy loss Memory loss Weight loss or gain Difficulty thinking Loss of concentration Sense of worthlessness or quilt Sleeping (insomnia or sleeping too much) Suicide MANIA Extreme elation Inflated self-esteem Decreased need for sleep Racing thoughts Physical activeness Increased talkativeness Increased risk-taking BIPOLAR-AFFECTIVE Mood swings or cycles Tends to run in families Often treated with lithium Come off meds when feeling better & cycle starts over again Some enjoy manic phase because feel so creative Anxiety Disorders Generalized anxiety Panic attack Phobias Posttraumatic Stress Disorder Obsessive-Compulsive Disorder Dissociative Identity Disorder ANXIETY DISORDERS Intense fear or panic that appears to be unjustified Always anticipates disaster Symptoms Shortness of breath Increased heart rate Dizziness Chest pains Fear dying or going insane Panic Attack: 4 or more: Chest pain or discomfort Heart pounds, races or skips beats Chills or hot flashes Choking sensation Feeling unreal or detached from self Fear of dying Dizzy, lightheaded, faint or unsteady Nausea or other abdominal discomfort Numbness or tingling Sweating Shortness of breath or smothering sensation Trembling Phobias Social Phobia Most common phobia Irrational fear of situations where may be watched & judged by others Public speaking Trembling, sweating, racing heart Avoids situations Agoraphobia Claustrophobia Posttraumatic Stress Disorder (PTSD): Criteria Experienced or witnessed a traumatic event that has both of these elements Actual or threatened death or serious injury to self or others Felt intense fear, horror or helplessness War, rape, 9/11, Katrina, Virginia Tech, etc. 9/10 Iraq & Afghanistan veterans in VAs Posttraumatic Stress Disorder (PTSD): Criteria Repeatedly relives the event in at least 1 way: Intrusive, distressing recollections in thoughts or images Repeated, distressing dreams Flashbacks or illusions that feel like the event is recurring Mental distress in reaction to internal or external cues that symbolize or resemble the event Physiological reactivity – such as rapid heart beat, increased blood pressure in response to these cues Posttraumatic Stress Disorder (PTSD): Criteria Repeatedly avoids the traumarelated stimuli & has numbing or general responsiveness in 3 Tries to avoid thoughts, feelings, conversations connected to event Tries to avoid activities, people or places that recall the event Cannot recall an important feature of the event Posttraumatic Stress Disorder (PTSD): Criteria Repeatedly avoids the traumarelated stimuli & has numbing or general responsiveness in 3 Marked loss of interest or participation in activities important to person Feels detached or isolated from other people Restriction in ability to love or feel other strong emotions Feels life will be brief or unfulfilled Posttraumatic Stress Disorder (PTSD): Criteria At least 2 of symptoms of hyperarousal were not present before the traumatic event Insomnia Irritability Poor concentration Hypervigilance Increased startle response Obsessive-Compulsive Disorder 1/3 have onset before 15 Second peak time is 30s 1/50 adults Likely to persist throughout life with varying degrees of severity No known cause Inherited Shortage of serotonin Stress OBSESSIVE-COMPULSIVE DISORDERS Obsession: persistent preoccupation with unreasonable ideas or feelings Compulsion: irresistible impulse to perform irrational acts Obsession: cleanliness / Compulsion: handwashing Can have thoughts without behaviors Obsessive-Compulsive Disorder: Criteria For obsessions must have all: Recurring, persisting thoughts, impulses or images inappropriately intrude into awareness & cause marked distress or anxiety Ideas are not just excessive worries about ordinary problems Tries to ignore or suppress these ideas or neutralize them by thoughts or behaviors Insight that these ideas are a product of one’s own mind Obsessive-Compulsive Disorder: Criteria For compulsions must have all: Feels need to repeat physical behaviors (hand washing) or mental behaviors (counting things, silently repeating words) Behaviors occur as response to obsession or in accordance with strictly applied rules Obsessive-Compulsive Disorder: Criteria For compulsions must have all: Aim of behaviors is to reduce or eliminate distress or prevent something that is dreaded Behaviors are either not realistically related to the events they are supposed to counteract or they are clearly excessive for that purpose Obsessive-Compulsive Disorder: Criteria At some point, may recognize that obsessions or compulsions are unreasonable or excessive Obsessions &/or compulsions associated with 1: Cause severe distress Take up more than 1 hour/day Interfere with usual routine, or work, social or personal functioning Most Prevalent Obsessions Contamination fears of germs or dirt Imagining having harmed self or others Imagining loosing control of aggressive urges Intrusive sexual thoughts or urges Need to control things Most Prevalent Compulsions Repeated checking of doors, locks, electrical appliances, or light switches Frequent cleaning of hands or clothes Strict attempts to keep items in careful order Repetitious mental activities, such as counting or praying DISSOCIATIVE IDENTITY DISORDER (DID) Old multiple personality disorder Not multiple but fragmented Result of severe abuse Person develops “alters” to manage abuse Treatment is attempt to get all personalities reintegrated Personality Disorders Antisocial Personality Borderline Personality Self centered Manipulative Failure to reach potential Antisocial Personality Lack of regard for moral or legal standards of culture Marked inability to get along with others or abide by social rules Disregard of laws & rights of others Also called: Psychopaths Sociopaths Borderline Personality Disorder Rapid mood changes Intense, unstable interpersonal relationships Hard time controlling emotions Intense, inappropriate, uncontrollable anger Self-damaging impulsive behavior Compulsive spending, gambling, sexual behaviors Overly sensitive to criticism or rejection Considerations/Accommodations Stay calm & be supportive Ask how to help Clear/concise directions Empathy Patience Good feedback on how doing Refrain from expressing displeasure Considerations/Accommodations Know about medication side effects Sun sensitivity Dry mouth Sedation/drowsiness Blurred vision Fluctuations in ability Stress management programs Relaxation programs Expressive arts programs Considerations/Accommodations Physical activity can decrease anxiety Watch use of sharp supplies Transportation Scholarships Try to involve with others to decrease social isolation Others??? COMMUNICATING Confusion about what is real Difficulty concentrating Overstimulation Preoccupation with internal Be simple & straight forward Be brief, repeat Limit input; don’t force discussion Get attention before preceding COMMUNICATING Agitation Fluctuating emotions Withdrawal Belief in delusions Recognize & allow exit Don’t take words or actions personally Initiate conversations Don’t argue COMMUNICATING Discussion about voices Low self-esteem Acknowledge, but explain you do not hear them Stay positive & reinforcing